Ironman UK – Game On

So a few days after the last post, I was back in the doctors for yet more x-rays (I’ve had more than my fair dosage recently!) and to get the results of my MRI. I had my elbow x-rayed, which came back looking nice and calcified and well on its way to healing. The MRI results, however, put a big dent in my hopes for getting fit. Upon reading my report, my Doctor called in another specialist to come and take a look. I had done a number on my wrist, that’s for sure! The full report is below, but the short version is I fractured two bones (my triquetral and hamate), bruised two other bones (trapezium, which is what was originally a suspected scaphoid with my symptoms, and my capitate). The main problem was that the MRI had picked up a tear in my TFCC, which (correct my if I’m wrong) is a group of ligaments and cartilage that holds the radius and ulnar arm bones together and allows the forearm rotation, and essentially holds the wrist to the arm. Combined with my radial head (elbow) fracture, this is what is known as an Essex-Lopresti fracture, which essentially meant I was in the splint til it had healed. The fact that it was non-displaced and the radius and ulnar were still in the right place and the different fractured wrist bones was the confusing part, which is why the other specialist was drafted in. They were trying to work out how I actually landed (I had no cuts or grazes anywhere on my arm…) as apparently a non-displaced fracture of this type is very uncommon. The plus side of the non-displacement meant I was not going to need surgery on it to put it back into place, the downside of it was I was in a splint until it had healed; any further tearing and I was risking having the two bones pop apart, which would be surgery and in a cast for 3 months – not good!

For once, I was actually good with my recovery, and stayed in the splint religiously to allow it to heal. Running was still off the cards as any jolt risked tearing the TFCC further and swimming obviously was a definite no-no with half my range of movement in my elbow still missing.

3 weeks on and the injuries are finally starting to heal, after a couple of weeks of not much improvement. The last week, things have rapidly fallen into place (which, I would like to think coincides with return to some sort of normal training, but unlikely). My legs were slowly coming back on the turbo, I was back running and still running pretty well thanks to avoiding the kitkats and excessive meals whilst injured and I even ventured into the pool once most of the movement in my elbow returned.

The first swim back was an interesting one! Tubigriped-up to the max, I tentatively pushed off with my arms in front and attempted some single arm swimming. So far, so good. I then picked up the kickboard and even that was fine until it came to turning around (one arm holds the board, one arm grabs the edge to turn, either way, my fractured wrist was going to have to do something!). After 15 minutes of single arm and kick, and no pain, I decided it was time to try using both arms…and it was ok! I had absolutely no strength, which is a really weird feeling, but it didn’t really hurt! So happy!

The only concern I had was that in the evening, when for some completely stupid reason, I decided to see if I could lift myself up out of my chair with my arms (really, don’t ask) to see how my wrist was. I had forgotten I had a fractured elbow. With new-found mobility thanks to my swimming, I was fine until my arm was straight enough that the fracture was rubbing against my humerus….OW! Felt like I had refractured it again, what a complete tit! Thankfully the pain was short-lived and went, and what muscles I had left rallied around to prevent me doing it again and restricting my movement to pre-swim levels.

The other concerning issue was when I was brushing my teeth. At this point I was trying to live life as normally as possible (a check-up a week earlier showed everything was still in place, the TFCC had almost healed and I was allowed to start getting movement back) so I was brushing my teeth with my busted hand. When looking in the mirror I saw my ulnar protruding so prominently I nearly carted myself off to A&E there and then, worried I had knocked it out of alignment. Calming myself down, with no pain during arm bending and wrist rotation, I could at least wait a few days til my next check up. It wasn’t until I showed a friend at work, and they noticed how much smaller my arm was compared to the other one. It had never occurred to me but my muscle atrophy was shocking. If you bend your arm, you have a nice lump of muscle running down the upper arm to the lower arm – mine is completely flat and non-existent, even now after getting back in the pool and normal use! The reason my ulnar was so prominent was because I now had arms skinnier than Bradley Wiggins!

My final check-up was Tuesday, and the x-rays showed my wrist was still stable and the fractures looked good. With my elbow giving me more grief than my wrist, I requested another x-ray on it, which showed that it had not completely healed. The fracture had fused, but the fracture line was still visible in the x-ray, meaning it still had a little bit to go, probably at the top, which is why I don’t have full extension yet. However, he referred me to physio so I could ‘start and get everything moving again’. That was good enough to me, I had told him I was back swimming, cycling and running again, and he didn’t raise his eyebrows too much. It didn’t hurt, so he was happy with that, and didn’t tell me I shouldn’t! I neglected to mention the fact I was planning on doing my IM on Sunday, but that was permission good enough for me! Game On!

Yesterday morning saw me start to switch my body clock to IM time, and an early start saw me back in the pool 10 hours after leaving. My swim on Monday lasted 45 mins until my elbow died, but it felt OK yesterday morning. My replacement helmet also arrived this week, so I ventured out on the roads at six yesterday. It felt very alien, and very weird after 5 weeks exclusively in the TT position, but being back out on my bike made me so happy! I just have a few days now to get stregth back in my arm, and have been spending lots of time in the pool to try and build the muscle back, as well as trying to use it normally, including typing and playing xbox and guitar (definitely a medical recommendation that…) This morning was my final day of proper training, and saw me getting up at 5 for a run, cycling to the pool, having a good pool session where my arm is really starting to feel strong again, and cycling home. The grief my arm gives me seems to switch between my elbow and wrist. I think the elbow fracture has just about finally healed, and full extension has almost returned and the muscle is helping to protect it, I just hope it holds for the swim. My wrist is still very weak, so will be strapping my wrist up rugby-style, as well as wearing a double tubigrip. Day-by-day it is getting back to normal, I just hope my legs remember how to work now!

Scan findings:
Marrow signal is intensely increased within the triquetral on STIR, with associated intense signal increase within the trapezium and to a lesser extent within the ulnar border of the distal capitate (images 07-10 of series eight).

There is preservation of radio/ulna carpal joint space and alignment.

The TFCC is of altered signal, with evidence of a partial tear of its distal attachment to the capsule. The scapholunate ligament, lunotriquetral ligament and radioscaphocapitate ligaments are intact.

The flexor extensor tendons appear normal.

The median and ulnar nerves appear of normal signal and calibre.

There is marked ulnar sided synovitis seen.

Interpretation:
1.) Undisplaced fracture of the triquetral, and the dorsal aspect of the hamate, with no significant displaced fragments.
2.) Associated dorsal synovitis, that may mask a small avulsion fragment.
3.) Bone contusion of the trapezium, and ulnar margin of the capitate.
4.) Compromise to the capsular attachment of the TFCC with ulnar gutter synovitis.

For clarification of the morphology of the fracture of the dorsal triquetral and hamate further, a CT may be useful.